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                 M E M B E R S H I P   F O R M   F E E D B A C K
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Name:     [membership_name]
Email:    [membership_email]
Location: [membership_location]

Home phone: [membership_hphone]
Work phone: [membership_wphone]

membership type:
	15 : [membership_15]
	25 : [membership_25]

Userid:   [membership_userid]
password: [membership_password]

Comments:
[membership_comments]

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